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John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

John over at Chilmark Research has a really good find on his blog. He quotes the new head of ONC, David Blumenthal, from an article in the New England Journal of Medicine (NEJM) where Blumenthal talks about the certified EHR requirement in the HITECH act. Here’s the quote:

ONCHIT currently contracts with a private organization, the Certification Commission for Health Information Technology, to certify EHRs as having the basic capabilities the federal government believes they need. But many certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for ONCHIT.

I find it really interesting how two people can take the same quote different directions. Chilmark Research gives a nice little rant about how you can’t certify usability, quality and efficiency in an EHR. I agree with him on most points and I definitely agree that the market is much better at these three items than some government certification body.

However, I don’t feel like this was what Blumenthal meant in the above quote. I don’t think Blumenthal was trying to say that the certification would need to certify user-friendly, quality and efficient EHR software. Instead, I see the above quote meaning that the current CCHIT certification isn’t good enough, because it has certified a bunch of unusable EHR (a topic we’ve talked about many times before). Sounds to me that Blumenthal is making a case for why the government shouldn’t use the CCHIT certification. At least not in its current form. Essentially Blumenthal is saying that CCHIT isn’t good enough to meet the goals of HITECH.

This seems like a ray of hope for myself and others who think that selecting CCHIT certification as the certified EHR requirement of the HITECH act is the worst decision the government could make. Albeit still just a ray.

What Blumenthal means about “tightening the certification process” is up for debate. He could mean something like what John from Chilmark research describes. Basically some convoluted method of measuring usability, quality and efficiency of an EHR system. Or it could mean that the certification process will need to be tightened so that unneeded requirements are removed and it gets cut down to what will help an EHR achieve the ambitious goals of the HITECH act.

Of course, in the end the certified EHR criteria will probably land somewhere in between. However, this quote did give me some hope that Blumenthal realizes the impact that it will have on EHR adoption if many of the currently unusable certified EHR gain wide adoption thanks to the $18 billion in EHR stimulus money.

I do think John from Chilmark Research does make a nice conclusion to his post:

Suggesting that we tighten the certification process is heading in the wrong direction. Instead, we need to actually relax the certification process to encourage innovation in the HIT market allowing developers to create solutions that will truly provide value to their users while concurrently meeting the broader objectives of delivering better care and better outcomes. Creating light certification criteria and focusing more on what outcomes we wish to see occur as a result of broad HIT adoption is where Blumenthal and his staff need to focus their energies.

If I was in vegas (which I guess I am), I’d put my money on CCHIT being the certification. I have a small sliver (very small sliver) of hope that the government will offer some other alternative to CCHIT as well, but it’s pretty unlikely I think. Which is unfortunate, because isn’t making CCHIT the certification body essentially creating a monopoly?

I agree with John from Chilmark. The certification process should be very loose. It should require robust functionality in a few key areas but then leave lots of flexibility for innovation. We need to let EMRs “evolve” to become the best they can be! The key characteristics is that physicians should like them, they should “save time”, they should make our care more efficient and they should lead to a higher quality of care and a higher satisfaction rate amoung providers and patients. This evolution should be driven by “the market” rather than the government or “the big emr companies”!

I also agree with John from Chilmark. I am trying to bring a doctor client into the web world with a simple intake form to edit and store basic “current” data about a patient. I tried to find an example of an xml template to use for data storage, and could find nothing that didn’t try to “count the angels on the head of a pin” — over 16K xml lines in the PHR example I found.

Ultimately, I decided to just store the data in simple plain-text and deal with any interoperability standard later. “Just Do It!”

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